Clinical Investigation of Flat Pack Toric Contact Lenses and Wearer Attitudes to Environmental Impact.

OBJECTIVES: To investigate the performance of a novel flat pack toric daily disposable contact lens compared with traditionally packaged toric lenses in a randomized, crossover study. Environmental attitudes to contact lens wear were also explored. METHODS: Habitual contact lens wearers were recruited to wear a hioxifilcon A (Miru 1 day Flat Pack Toric, Menicon, Nagoya, Japan) test lens and a control lens: either nelfilcon A (Dailies AquaComfort Plus, Alcon, Geneva, Switzerland) or etafilcon A (1-Day Acuvue Moist, Johnson & Johnson, New Brunswick, NJ). Objective lens performance was assessed at fitting, and participants wore lenses in a randomized order for three consecutive days. Subjective measures of lens performance (comfort, vision, and handling) were then assessed by a questionnaire, with further questions on overall lens preference and environmental perceptions. RESULTS: Objective measures of lens fit were similar for the test and control lenses, except for distance VA which was better with the control lenses ( P <0.05; difference of two logMAR letters). End of day comfort was greater with the test lens, but this did not reach significance. Both lenses demonstrated similar scores for overall satisfaction. 87.5% of participants indicated the environmental impact of contact lenses to be important/extremely important to them, with 100% of participants identifying the flat pack packaging as having a smaller environmental impact. CONCLUSION: Overall, the lenses used in the study performed to similar levels. Environmental credentials are important to contact lens wearers, which may contribute to overall lens preference.

BCLA CLEAR Presbyopia: Epidemiology and impact.

The global all-ages prevalence of epidemiologically-measured 'functional' presbyopia was estimated at 24.9% in 2015, affecting 1.8 billion people. This prevalence was projected to stabilise at 24.1% in 2030 due to increasing myopia, but to affect more people (2.1 billion) due to population dynamics. Factors affecting the prevalence of presbyopia include age, geographic location, urban versus rural location, sex, and, to a lesser extent, socioeconomic status, literacy and education, health literacy and inequality. Risk factors for early onset of presbyopia included environmental factors, nutrition, near demands, refractive error, accommodative dysfunction, medications, certain health conditions and sleep. Presbyopia was found to impact on quality-of-life, in particular quality of vision, labour force participation, work productivity and financial burden, mental health, social wellbeing and physical health. Current understanding makes it clear that presbyopia is a very common age-related condition that has significant impacts on both patient-reported outcome measures and economics. However, there are complexities in defining presbyopia for epidemiological and impact studies. Standardisation of definitions will assist future synthesis, pattern analysis and sense-making between studies.

The impact of COVID-19 on soft contact lens wear in established European and US markets.

PURPOSE: To characterise changes in soft contact lens wearing habits during the COVID-19 pandemic. METHODS: A detailed online questionnaire was circulated to individuals aged 40-70 years, during the period April to May 2021. Data sampling took place in the United Kingdom (UK), United States of America (USA), Netherlands, Germany, France, Spain and Italy. Only data pertaining to individuals who were soft contact lens wearers were included. Data were extracted for questions relating to contact lens wearing habits pre- and during the COVID-19 pandemic, and expectations for future lens wear beyond the pandemic. RESULTS: Seven-hundred and twenty-eight individuals were identified as soft contact lens wearers of which six-hundred and nineteen wore a combination of contact lenses and spectacles. Most respondents indicated contact lens wear times had either remained the same (57.3%) or increased (9.8%) during the pandemic. The country with the greatest proportion of respondents decreasing wear time during COVID-19 was the UK (45.3%), and the least in the Netherlands (20.0%). The primary cause of decreased lens wear was attributed to leaving the home less often (70.0%), and the second most common reason due to concerns about hygiene (10.8%). Most respondents (83.9%), however, expressed a desire to return to pre-pandemic wear times once the pandemic was over. CONCLUSIONS: Practitioner concerns about contact lens market recovery ought to be assuaged by the survey outcomes which show most individuals to have maintained lens wear during the pandemic. In view of the continued lens wear, as and when restrictions ease, ECPs may wish to encourage patients to return for routine check-ups that may have been missed due to the pandemic.

Exploring contact lens opportunities for patients above the age of 40 years.

PURPOSE: Contact lenses offer a good option for patients with presbyopia, especially with improved optical designs available in modern multifocal contact lenses. Due to the ageing population there is good opportunity to increase contact lens penetration by managing these patients better. However, multifocal contact lenses achieve low penetration in the market. METHODS: A questionnaire was administered to people aged above 40 years, to investigate their perceptions of contact lenses for presbyopia. Only people, with presbyopia, who were existing contact lens wearers or willing to try contact lenses were included. Participants were recruited from United Kingdom (UK), United States of America (USA), Netherlands, Germany, France, Spain and Italy. RESULTS: Data from 1540 participants above the age of 40 years was collected, 57.9% were females and 42.1% males. Overall, 50.8% of the participants wore contact lenses, but contact lens wear was less common amongst older participants. Some data supported earlier studies, such as 6.1% wore gas permeable lenses. However, only 25% of the contact lens wearers used multifocal contact lenses. The reasons the participants wanted to wear contact lenses were similar to younger patient such as sports or cosmesis reasons. Reasons why participants had dropped out of contact lenses included discomfort and dry eye related issues. Poor visual performance with contact lenses was a reason to dropout of contact lenses for the older participants. CONCLUSIONS: The study highlights some failings by eye care practitioners in the management of patients with presbyopia. It seems that patients of this age group are seeking suggestions and recommendations from their eye care practitioner including upgrading contact lenses and dual wear options. The day-to-day problems encountered by the contact lens wearers in this study seem to be, in the main, things that could be easily tackled by additional counselling and instruction from the eye care practitioners.

Optimising subjective anterior eye grading precision.

PURPOSE: To establish the optimum grading increment which ensured parity between practitioners while maximising clinical precision. METHODS: Second year optometry students (n = 127, 19.5 ± 1.4 years, 55 % female) and qualified eye care practitioners (n = 61, 40.2 ± 14.8 years, 52 % female) had 30 s to grade each of bulbar, limbal and palpebral hyperaemia of the upper lid of 4 patients imaged live with a digital slit lamp under 16× magnification, diffuse illumination, with the image projected on a screen. The patients were presented in a randomised sequence 3 times in succession, during which the graders used the Efron printed grading scale once to the nearest 0.1 increment, once to nearest 0.5 increment and once to the nearest integer grade in a randomised order. Graders were masked to their previous responses. RESULTS: For most grading conditions less than 20 % of clinicians showed a ≤0.1 difference in grade from the mean. In contrast, more than 50 % of the student graders and 40 % of experienced graders showed a difference in grade from the mean within 0.5 for all conditions under measurement. Student precision in grading was better with both 0.1 and 0.5 grading increments than grading to the nearest unit, except for limbal hyperaemia where they performed more accurately with 0.5 unit increment grading. Limbal grading precision was not affected by grading step increment for experienced practitioners, but 0.1 and 0.5 grading increments were both better than the 1.0 grading increment for bulbar hyperaemia and the 0.1 grading increment was better than the 0.5 grading increment and both were better than the 1.0 grading increment for palpebral hyperaemia. CONCLUSION: Although narrower interval scales maximise the ability to detect smaller clinical changes, the grading increment should not exceed one standard deviation of the discrepancy between measurements. Therefore, 0.5 grading increments are recommended for subjective anterior eye physiology grading (limbal, bulbar and palpebral redness).